Boston University School of Medicine, Boston, MA, USA.
Pain Physician. 2013 Jan;16(1):77-88.
While the use of opioids for chronic non-cancer pain (CNCP) has increased dramatically in the past 2 decades, concern exists about the safety of opioids, particularly with the extensive use among individuals with CNCP.
To assess the risk of type 2 diabetes (T2D) among adults exposed to opioids for non-cancer pain.
Nested case-control study.
United Kingdom-based General Practice Research Database (GPRD).
Among 1.7 million opioid users with at least one prescription for an opioid to treat non-cancer pain in the GPRD (1990 - 2008), we identified all incident T2D cases with at least 2 years of medical history before their first diagnosis (index date). For each case we randomly selected up to 2 controls matched on age, gender, index date, and general practice. The same eligibility requirements were applied to controls as to cases. We defined "any exposure" as at least 2 prescriptions for an opioid within 2 years before the index date and defined "nonuse" as no use or only one prescription within 2 years (reference). For any exposure to opioids we further evaluated timing of use, cumulative use, and individual opioid type. Conditional logistic regression was used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) controlling for confounders.
We identified 50,468 T2D cases to which we matched 100,415 controls. Cases were more likely than controls to be former smokers, heavier, and to have more co-morbidities, co-medications, and visits to their general practitioners. After adjusting for important confounders there was no increased risk for T2D among those exposed to any opioid compared to nonusers (AOR = 1.03, 95% CI 1.00 - 1.06). The results did not change when we evaluated timing of use, cumulative use, or individual opioid type.
Misclassification of exposure may have occurred; limited data for some individual opioid types.
This study found no association between use of opioids and risk of T2D among non-cancer adults.
在过去的 20 年中，尽管阿片类药物在慢性非癌症疼痛（CNCP）中的使用大幅增加，但人们对阿片类药物的安全性仍存在担忧，特别是在 CNCP 患者中广泛使用的情况下。
评估非癌症疼痛患者使用阿片类药物的 2 型糖尿病（T2D）风险。
巢式病例对照研究。
英国基于全科医生研究数据库（GPRD）。
在 GPRD 中（1990-2008 年），有 170 万阿片类药物使用者至少有一份处方用于治疗非癌症疼痛，我们在他们的第一次诊断（索引日期）之前至少有 2 年的病史，确定了所有新确诊的 T2D 病例。对于每个病例，我们按年龄、性别、索引日期和全科医生随机选择最多 2 名匹配的对照。对照的纳入标准与病例相同。我们将“任何暴露”定义为索引日期前 2 年内至少有 2 次阿片类药物处方，将“非使用”定义为 2 年内无使用或仅 1 次处方（参照）。对于任何阿片类药物的暴露，我们进一步评估了使用时间、累积使用量和个别阿片类药物类型。条件逻辑回归用于估计调整后的比值比（AOR）和 95%置信区间（CI），同时控制混杂因素。
我们确定了 50468 例 T2D 病例，与之匹配了 100415 例对照。与对照组相比，病例更有可能是前吸烟者、体重较重，且合并症、合并用药和就诊次数更多。在调整了重要混杂因素后，与非使用者相比，任何阿片类药物暴露者的 T2D 风险均无增加（AOR=1.03，95%CI 1.00-1.06）。当我们评估使用时间、累积使用量或个别阿片类药物类型时，结果并未改变。
暴露的分类可能存在错误；某些个别阿片类药物类型的数据有限。
本研究未发现非癌症成人使用阿片类药物与 T2D 风险之间存在关联。
